<div id=tiga_ba>
	<div id=tiga_baa>Tambah Layanan</div>
	<div id=tiga_bab></div>
	<div class=clear></div>
</div>
            
<form action="utama.php?module=mod_layanan&act=simpan" onsubmit="return gsValidate('kode|layanan|jenis','Kode Layanan Harus Diisi|Nama Layanan Harus Diisi|Jenis Layanan Harus Dipilih','required|required|required');" method="post" enctype="multipart/form-data">
	<table style="margin: 10px 15px 10px 15px;">
		<tr>
			<td>Kode Layanan</td>
			<td>&nbsp;</td>
			<td>
				<input name="kode" type="text" class="input_small" id="kode"/>
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Nama Layanan</td>
			<td>&nbsp;</td>
			<td>
				<input name="layanan" type="text" class="input2" id="layanan"/>
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Jenis Layanan</td>
			<td>&nbsp;</td>
			<td>
				<select name="jenis" class="input2">
					<option value=""> - - Pilih Jenis Layanan - - </option>
					<?php
						$jenis = mysql_query("select * from jenis_layanan");
						while($j=mysql_fetch_array($jenis)){
							echo "<option value=$j[id_jenis_layanan]>$j[jenis_layanan]</option>";
						}
					?>
				</select>
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td><input name="submit" type="submit" class="button" value="Simpan" /></td>
		</tr>
	</table>
</form>		
            
        